Sunday, September 18, 2016

Recurring problem in Delhi - Chikungunya, dengue, malaria - When will we learn our lesson

Each year during rainy season and weeks after it, Delhi turns into a breeding ground for mosquitoes. Umpteenth people get affected and hospitals get swarmed with chikungunya, dengue and malaria patients. The problem is that these mosquito-borne diseases are difficult to diagnose, given the similar symptoms they have with fever being a prominent part.

If these key differences are not detected and treated on time, the diseases could definitely prove hazardous.

This disease is caused by the transmission of plasmodium — a parasitic protozoa — into the body’s system. There are two types of plasmodium species that are common in India — Vivax and Falciparum, which are transmitted into the human bodies through the spit of Anopheles mosquitoes. The Anopheles mosquitoes bite usually during the day.

The most common symptom of Malaria is high-grade fever. But, the fever does not stay at a stretch and is intermittent i.e. comes over a period of two-three days. The fever is accompanied with chills and rigor. In severe cases, the patient suffers from constipation, disorientation (in the case of cerebral malaria) and kidney dysfunction.

This viral disease is transmitted to human bodies through the bite of female Aedes mosquitoes and from an infected human to another, in cases of blood transfusion. The dengue causing mosquitoes usually bite during the night.

The patient suffers from fever for the initial three-four days, followed by body pain. Retro-orbital pain ie. pain behind the eyes is also common. In acute cases, decreased urine output, respiratory difficulties and increased bleeding tendencies also accompany the usual symptoms.

Chikungunya is caused by the same female Aedes mosquitoes that cause dengue. This ailment mostly affects the muscle cells of the body.

The prominent symptoms of Chikungunya include excessive body pain or myalgia, swelling in the joints and rashes across the body. The body pain, in this case is more severe than that in dengue cases.

In chikungunya, joints pain is more pronounced, while in cases of dengue, patients might even feel retro-orbital pain, that is, pain behind the eyes. Other than this, the symptoms for both mosquito-borne diseases are the same.


While for Malaria, anti-malarial drugs like chloroquine and artemisinin are available, dengue and chikungunya are viral diseases and do not have treatment drugs as such. The treatment for dengue and chikungunya is symptomatic and therefore, doctors wait for the symptoms to become evident in the body.

Chikungunya and dengue patients are given paracetamol for the fever to subside, but not in the first three days. Since both the diseases have similar symptoms, giving any kind of medicines, including painkillers in the first two-three days is fatal. It could lead to bleeding, in some cases. The patients are prone to dehydration and therefore, are advised to increase their intake of fluids.

Some of the prevention method that people can take are using the good old mosquito nets during night. One of the key things is to avoid getting bitten by mosquitoes because there are no medical ways or vaccines to avoid prevention of these diseases. Wear clothes that cover you fully and apply mosquito-repellent creams. As a community, to prevent such diseases, ensure that there is no water stagnation in the surroundings, because they become excellent breeding grounds for mosquitoes. Also, make sure that your living area and surroundings are hygienic and clean. Change the water in room coolers at least once a week.

Overuse of Medications can cause liver problems

Alcohol is not the only cause of liver damage. Overuse of Medications can cause liver problems too. In the extreme cases it can lead to liver failure.

Overuse of over-the-counter drugs and certain prescription drugs is known to cause liver damage. Some of these drugs include antidepressants, mood stabilizers, corticosteroids (used for treating inflammation) and pain relievers. It’s therefore important to review the side effects and adverse effects of medications before taking them.

Even many of the prescribed medicine in India can cause liver inflammation and liver problems. For e.g. Drugs containing sulfonamides prescribed by many doctor. But they are also known to cause idiosyncratic liver injury. Hepatotoxicity appears to be a class effect, in that virtually all sulfonamides used today have been linked to rare, but convincing cases of drug induced liver injury. Most typically, the injury appears within one to three weeks of starting therapy, often preceded or accompanied by signs of hypersensitivity such as fever, rash, facial edema, lymphadenopathy, arthralgias, and eosinophilia or atypical lymphocytosis (or both). Hepatotoxicity from sulfonamides may represent a part of a spectrum of hypersensitivity due to sulfa-derived medications and have been linked to many cases of DRESS (drug rash with eosinophilia and systemic symptoms) as well as Stevens Johnson syndrome and toxic epidermal necrosis. The severity of injury varies widely. Most instances of sulfonamide related liver injury are mild-to-moderate in severity and self-limited in course. Importantly, sulfonamides can cause acute liver failure, particularly in instances with a precipitious onset and hepatocellular pattern of serum enzyme elevations. Indeed, the sulfonamides remain one of the most common causes of drug induced acute liver failure.
In one of the instances, an old lady in New Delhi was given sulfonamide drug which caused sever itching in her body and led to liver inflammation. Her condition deteriorated with swelling on face and arms but luckily the doctors identified the cause of the problem and she was able to recover in due course.

Tuesday, September 13, 2016

Ayurvedic herbs can treat liver problem including Fatty liver, Hepatitis, Cirrhosis, Ascites and Jaundice

Kamalahar is enriched with various herbs proven to be very effective for the treatment of liver problems. It has Tecoma undulata, Phyllanthus urinaria, Embelia ribes, Taraxacum officinale, Nyctanthes arbortritis and Terminalia arjuna.

Tecoma undulata is an herb which is proven to have medicinal property that helps in curing liver diseases especially for the treatment of hepatitis. It is also used in curing urinary disorders, enlargement of spleen, gonorrhea and leucoderma. Seeds are used against abscess.

Phyllanthus urinaria has been used for centuries to promote healthy elimination of gallstones and kidney stones. It is also used for the treatment of liver disease especially hepatitis B. Phyllanthus urinaria primarily contains lignans (e.g. phyllanthine and hypophyllanthine), gallic acid, alkaloids, and bioflavonoids (e.g. quercetin). While it remains unknown as to which of these substances has an antiviral effect, researchers believe that this herb acts primarily on the liver. Other research has revealed other possible benefits like helping to soothe the liver, detoxification of the liver and kidneys, relief from pain and inflammation, reducing oxidative stress, and an ability to inhibit hepatitis B virus DNA replication. It is believed that the possible benefit that phyllanthus urinaria provides in cases of liver damage could be due to the plants anti-viral activity. In Ayurvedic medicine, Phyllanthus has been used for over 2000 years in India for many medicinal uses for those with liver disease including hepatitis.

Embelia ribes is quite beneficial in the treatment of liver ailments especially jaundice and also for strengthening the body. It also helps with gastric problem by either preventing formation of gas in the gastrointestinal tract or facilitates the expulsion of gas. It is also quite useful against tape-worms. It is believed to be useful against skin diseases, bronchitis, urinary discharges, Dyspepsia, hemicrania, worms in wounds etc.

Taraxacum officinale is believed to have a medicinal value, in particular against liver problems. It is also known to be a Diuretic and quite beneficial in the treatment of liver cirrhosis. It is also used in herbal medicines as a mild laxative, for increasing appetite, and for improving digestion. The milky latex has been used as a mosquito repellent and as a folk remedy to treat warts.

Nyctanthes arbortritis is known for its important place in Hindu mythology and this plant has many common names like Indian Night Jasmine. The flower, seeds and leaves of the plant are diuretic, antibacterial, anthelmintic, anti-inflammatory, hepatoprotective, immunopotential, anti pyretic, antioxidant, anti fungal, anti-bilious, sedative and antifilarial. It is useful in the treatment of many diseases including liver disorder. Its extract has proven by researchers to have significant hepatoprotective activity, which is ability to prevent damage to the liver and also hepatoregenerative. The herb in combination with other herbs is quite beneficial in the treatment of hepatitis, cirrhosis, alcohol liver diseases and other liver disorders. Apart from liver disorder, the herb has been used in the treatment of affections of scalp, rheumatic joint pain, malaria, snakebite, bronchitis, sciatica, chronic fever, rheumatism, internal worm infections, high blood pressure, diabetes, piles and skin diseases. Some people have also used the herb in the treatment of cancer.

Terminalia arjuna is high in co-enzyme Q-10 and helps in the treatment of cirrhosis of liver and reduces blood pressure.The arjuna was introduced into Ayurveda as a treatment for heart disease by Vagbhata. It is traditionally prepared as a milk decoction. In the Ashtānga Hridayam, Vagbhata mentions arjuna in the treatment of wounds, hemorrhages and ulcers, applied topically as a powder.
The combination of these herbs is what makes Kamalahar very effective in the treatment of liver disorders including hepatitis, cirrhosis, fatty liver, ascites and jaundice.

80% of fatty liver disease patients in Korea don't drink alcohol

One in three Koreans suffers from fatty liver disease. Fatty liver disease is a condition that occurs when large amounts of fat accumulate in liver cells. Despite having multiple causes, fatty liver disease is considered to be caused mostly by excessive alcohol intake.

However, latest research shows that 80% of patients with the disease in Korea do not drink alcohol. In fact the number of patients with non-alcoholic fatty liver disease has doubled in the last 6 years.
Experts now say that the biggest factor in causing the disease is carbohydrates.
Compared to people who eat less carbohydrates, men and women who intake a lot of carbohydrates are 1.7 times and 3.8 times more likely to suffer from fatty livers, respectively.

The fatty liver disease is prevalent among Koreans because Korean people tend to eat a lot of carbohydrates. It's important to reduce the intake of other kinds of carbohydrates such as food made of flour and noodles.

Obesity is another factor that can lead to non-alcoholic fatty liver disease.
This explains why fatty liver disease is being observed among many parents in their 40s and 50s and among overweight children as well.
If left unattended, fatty liver disease can develop into fatal diseases such as cirrhosis and even liver cancer.
To prevent this, doctors advise citizens to exercise for at least 10 minutes a day, watch their eating habits and visit the doctor for regular check-ups.

Sunday, September 11, 2016

Dengue virus and its treatment can affect liver

In a dengue patient, the virus and the painkillers are a double whammy that can leave the liver scarred. During an attack, a patient pops painkillers and paracetamols. When they act, the body exacts a cost for suppressing the pain by affecting the liver since this organ treats all painkillers as poison, even paracetamol. So a patient is caught between taking and not taking medicines and a damaged liver takes months to recover.

A large percentage of dengue patients end up with such liver dysfunction. Experts who have observed the patients said levels of certain enzymes and proteins in patients' blood go up or drop in reference to the normal count indicating liver problems.

Abdominal pain, vomiting and loss of appetite are the earliest symptoms. Yellowish discolouration of the eyes or urine and abdominal tenderness are warning signs of liver damage.

Counselling high-risk patients with underlying medical conditions like diabetes and hypertension, stopping medications like paracetamol, known to deteriorate liver function, is still the first line of care. Patients also need supportive care, proper hydration and consistent monitoring of liver function indicators through blood tests.

Dengue virus attacks the cells that cause inflammation in the liver. The Alanine Aminotransferase (ALT) and Amino Alanine Transferase (AST) enzymes increase in number in the blood during the time and may cause complications including damage to liver.

Liver damage in dengue infection is not preventable, but doctors can reduce paracetamol and other medicines which can cause liver toxicity. Liver involvement is more commonly seen in those who have dengue haemorrhagic fever, a severe form of dengue. Early detection can help save lives.

The most commonly used indicators of liver damage are alanine aminotransferase (ALT) and aspartate aminotransferase (AST), referred to as the SGPT and SGOT.

Levels of these enzymes usually begin to increase from an early stage (day 1-3 of illness) and peak during the second week of illness. Proper medical care can help avert liver damage.

Saturday, September 10, 2016

India can learn a lesson or two from Egypt on how to deal with hepatitis

In 2006, when Egypt formed a national committee to control the spread of Hepatitis, the country was known to have the highest burden of the disease globally. India, at the time, had still not acknowledged its growing Hepatitis numbers, while focusing on HIV and Tuberculosis.

Over the past decade, Egypt has come a long way, reducing Hepatitis prevalence from 4.5 per cent then to 1 per cent now, and, in the process, has provided a roadmap for the World Health Organisation (WHO) and countries like India, which is grappling with an estimated 6 million Hepatitis C (HCV) and 40 million Hepatitis B (HBV) cases.

The syringe culture is similar in Egypt and India. People take less oral medication and prefer injections. Syringe safety is necessary to prevent new cases. Egypt raised awareness on the use of sterile razors in barber shops, use of new instruments for pedicure and manicure and on the use of disposable syringes for patients. It’s all about advocacy. There should be multiple stakeholders like the government, politicians, the media and individuals from different sectors who wish to bring this health problem into the limelight.

The Egyptian government also urged Hepatitis drug manufacturing companies to lower costs. Direct cost of hepatitis treatment there was estimated at $ 670 million and the country was able to treat its patients at 1/10 the global price of the drugs.

The Hepatitis pool grew in Egypt in the 1950s and 1960s due to the reuse of glass syringes after boiling. It is believed that similar unsafe syringe practices have led to the increased cases in India. 

Egypt has now introduced a birth-dose policy to prevent new infections. The prevalence of HCV in Egyptian children has dropped to 0.8 percent from the 1.5 percent a decade ago.

The Union Ministry of Health and Family Welfare has begun a vaccination drive for newborns against HBV under Mission Indradhanush, that is aimed to prevent seven diseases in infants. Since 2014, over 40 lakh children have been covered under the scheme. But there still stands no active diagnosis or free treatment programme for Hepatitis adult patients unlike AIDS or Tuberculosis.

The Health ministry has also roped in Bollywood actor Amitabh Bachchan to become the face of the campaign. Although delayed, the government is slowly moving towards disposable syringes with Maharashtra becoming one of first states to embrace one-time usable syringes.

Hopefully, in due course we can learn and implement many of the policies that have been successful in Egypt

Friday, May 27, 2016

Fatty liver may increase the risk of heart disease

Patients suffering from fatty liver disease is prone to an increased risk of heart disease as well as the mortality rates associated with it, a new study has found.

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common condition in patients with obesity, type 2 diabetes and arterial hypertension -- where high blood pressure in the arteries is persistently elevated.

The findings showed that NAFLD is an independent risk factor for atherosclerosis -- the build-up of fats, cholesterol and other substances in and on the artery walls -- which may lead to the advent of cardiovascular disease (CVD) -- heart diseases -- related deaths.

Evidence indicates that the fatty and inflamed liver expresses several pro-inflammatory and procoagulant factors, as well as genes involved in accelerated atherogenesis. This raises the possibility that the link between NAFLD and cardiovascular mortality might not simply be mediated by shared, underlying, common risk factors, but rather that NAFLD independently contributes to increasing this risk.

In patients with metabolic syndrome health problems like diabetes and stroke at risk for heart disease events, NAFLD contributes to early atherosclerosis and its progression, independent of traditional cardiovascular risk factors.

This indicates that NAFLD is a precursor of metabolic syndrome. It follows that the diagnosis of fatty liver is extremely important and therefore a thorough cardiovascular and metabolic work-up and strict monitoring of CVD or metabolic complications are needed in the clinical management of NAFLD.

Using the Fatty Liver Index (FLI) a well-validated biomarker, researchers observed that fatty liver is associated with thickness in the major blood vessels in the neck -- a pre-atherosclerotic problem that predicts heart disease events.

Thickness in the blood vessels increases proportionally with FLI, and this association is independent of traditional cardiometabolic risk factors -- like diabetes, heart disease or stroke.

Futher, patients with fatty liver were more likely to develop in the plaques resulting in thickness in the blood vessels over time. Fatty liver disease at baseline predicted the occurrence of carotid plaques independent of age, sex, type 2 diabetes, tobacco use, and other heart disease risk factors. Strict monitoring of cardiovascular disease is recommended when managing nonalcoholic fatty liver disease, the researchers suggested.